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General NPI Number Information
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NPI Number | 1922464577
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Entity Type | Organization
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Legal Business Name | REALM CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 2860 MIDDLE ST
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City | LITTLE CANADA
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State | MN
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Zip | 55117-1411
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Country | US
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Telephone | 701-740-8870
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Fax |
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Provider Business Mailing Address
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Address Line | 2860 MIDDLE ST
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City | LITTLE CANADA
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State | MN
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Zip | 55117-1411
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Country | US
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Telephone | 701-740-8870
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN DOUGLAS KENNEDY
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Credential | DC
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Telephone | 701-740-8870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6182
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License Number State | MN
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